Provider Demographics
NPI:1366581589
Name:ENDOCRINOLOGY NUCLEAR MEDICINE ASSOCIATES PA
Entity type:Organization
Organization Name:ENDOCRINOLOGY NUCLEAR MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-223-5483
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 374
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5615
Mailing Address - Country:US
Mailing Address - Phone:210-223-5483
Mailing Address - Fax:210-223-5492
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 374
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5615
Practice Address - Country:US
Practice Address - Phone:210-223-5483
Practice Address - Fax:210-223-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083522501Medicaid
TX00K56QMedicare ID - Type Unspecified